Heroin Puts Burma in Crisis Over AI

Dear Friends and Associates,
The following
article is from today's New York Times.
Sincerely,
Julien Moe
-------------------
May 3, 1998
Heroin Puts Burma in Crisis Over AIDS
By CHRISTOPHER S. WREN
ANGOON, Burma -- At sidewalk tea stalls where Burmese men
socialize over cups of fragrant
black tea, proprietors in some towns have added a lucrative
sideline -- heroin -- and use the same
syringe to inject as many as 40 customers.
The surreptitious practice, described by several Western diplomats
and doctors, illustrates how Burma,
the world's foremost exporter of opium, has developed its own
domestic heroin habit, with potentially
disastrous consequences.
So many young Burmese are injecting heroin that some medical
experts say Burma, also known as
Myanmar, has the world's highest rate of HIV infection and AIDS
contracted from dirty needles. By
1994, the Global Program on AIDS of the World Health Organization
reported, 74 percent of drug
addicts in Rangoon (also known as Yangon), 84 percent in Mandalay
and 91 percent in Myitkyina, in
the north, had HIV, the virus that causes AIDS.
This compares with about one-third of New York City's 150,000 to
200,000 intravenous drug users who
are HIV-positive, according to Donald Des Jarlais, research
director for the Chemical Dependency
Institute at Beth Israel Medical Center in New York.
The Burmese government has reported registering only 60,000
addicts, with as few as 17,000 infected
with AIDS. Foreign medical researchers put the total number of
addicts closer to 500,000, and estimate
that several hundred thousand heroin injectors have become
HIV-positive.
Another study, financed by the United Nations Drug Control
Program, a terse abstract of which was
released by the Burmese Health Ministry, found drug abuse
prevalent in 1.7 percent to 25 percent of
the population studied in three dozen Burmese townships. With 88
percent to 99 percent of drug
abusers identified as male, the study implied that up to half of
the men in some townships could be
addicted.
Both studies are cited in a new book, "War in the Blood: Sex,
Politics and AIDS in Southeast Asia," by
Dr. Chris Beyrer, an American epidemiologist who has worked in the
region and interviewed health
workers, addicts and people with AIDS.
"It's going to be one of those situations where people will say,
'How could the world not have known,
because hundreds of thousands of people have died there?"' he said
in a telephone interview from his
office at Johns Hopkins School of Hygiene and Public Health in
Baltimore.
Burma offers a harrowing example of drug-producing or transit
countries that find their own people
growing addicted to heroin or cocaine intended for foreign markets.
The military government's own AIDS statistics have been suspect
since 1996, when it wooed foreign
tourists with a "Visit Myanmar" campaign that portrayed the
country as a vacation paradise.
Beyrer said he knew of Burmese researchers who were punished for
being too candid about the
country's AIDS problem. Beyrer also said the military junta's
credibility was so suspect that even if
they told the truth, many Burmese might not believe them.
Although for years older hill people smoked opium to relax or as a
treatment for illnesses like malaria, it
is younger, lowland Burmese who are injecting opium's refined
derivative, heroin.
Dr. Ba Thaung, director of the Drug Dependence Research and
Treatment Unit in Rangoon, said that
heroin was widely available, inexpensive and devastatingly pure.
"Before, we had very few social
problems, but now we have a lot of problems connected to drug
use," he said.
Dr. Gyaw Htet Doe, a psychiatrist in the research unit of the
Rangoon drug treatment center, estimated
that 62 percent to 65 percent of younger heroin patients are
HIV-positive. "As a doctor at the Ministry
of Health, I have to be concerned because there is no cure for
this," he said. "It will kill or harm a lot of
young people in our country."
Other medical specialists made available by the government confirm
the problem. "The majority of
intravenous drug users are HIV-positive," said Dr. Martin Joseph,
a consulting psychiatrist at the
general hospital in Lashio, a town in northeastern Burma. "We
estimate about 80 percent."
The epicenter of Burma's AIDS pandemic is Hpakan, a jade-mining
town northwest of Myitkyina,
where heroin injection is said to be rampant and clean needles a
rarity. When seasonal rains halt the
digging in Hpakan's open-pit jade mines, thousands of migrant
miners return home, carrying the HIV
virus back to their wives.
The relatively late arrival of AIDS in Burma has contributed to
widespread ignorance about the
disease. By 1988, only a single case of AIDS, brought back by a
dying sailor, had been diagnosed. By
1989, doctors were discovering hundreds more Burmese infected.
Yet as late as 1995, a survey of 714 Burmese prison inmates found
that only 11 percent knew that HIV
could be contracted by injecting drugs. Dr. Than Zaw, medical
superintendent of the Lashio general
hospital, said that patients there "may have heard of AIDS but
they don't know how it's contracted."
"All they know is when they have AIDS, there is no cure," he
continued.
The government has opened 30 drug-treatment centers since 1975.
But many heroin users stay away,
because detoxification means undergoing agonizing withdrawal with
little more than modest doses of
tincture of opium and meditation lessons from Buddhist monks.
"Sometimes when they learn they are HIV-positive, they leave
treatment," Than Zaw said. "They don't
want their families or other people to know, because they are
looked down on."